ABSTRACT
Background: Serum Ferritin [SF] and iron both show acute phase responses to inflammation, so iron may fall and ferritin rise independent of the marrow iron store. Bone marrow iron store has been considered the gold standard, but is invasive, painful and expensive and not suitable for everyone. Serum transferrin receptor [sTfR] which is the concentration of the soluble fragment of transferrin receptor in serum, is an important new haematological parameter. The ratio of sTfR to log SF is known as sTfR-SF index. This study was conducted to evaluate sTfR, Ferritin and sTfR-F Index in diagnosing and differentiating iron deficiency anaemia [IDA] from anaemia of chronic disease [ACD]. Methods: One hundred and sixteen [116] adult subjects [80 anaemic and 36 controls] who already had their bone marrow examination done for various reasons were included in the study. sTfR, SF, and their index were measured and compared with bone marrow iron stores. Absence of iron stores denoted IDA whereas increased macrophage iron with decreased siderocytes and sideroblasts was diagnostic of ACD. Results: Out of 80 anaemic patients, 47 were diagnosed as IDA while 33 were diagnosed as ACD. In case of IDA the diagnostic accuracy of index was 91.57%, sTfR had accuracy of 85.54% while SF had accuracy of 75.90%. In case of ACD, the diagnostic accuracy of sTfR was 91.30%, index 89.86%, while SF had accuracy of 79.71%. Conclusion: sTfR-SF index is a better parameter than sTfR or ferritin alone but should only be used when the results of these parameters seem altered or a bone marrow aspiration is mandatory for diagnosis of ACD. The estimation of sTfR or index may offer a simple non invasive method that may enable more accurate assessments of iron status in such patients. Keywords: Serum Transferrin Receptor, Index, Iron deficiency anaemia
ABSTRACT
Immune thrombocytopenic purpura [ITP] is a clinical syndrome in which a decreased number of circulating platelets [thrombocytopaenia] manifests as a bleeding tendency, easy bruising [purpura], or extravasation of blood from capillaries into skin and mucous membranes [petechiae]. Present study was done to observe the clinico-haematological features of ITP in Adults and to analyse the association of autoimmune disorders with ITP in Pakistani patients. It was a cross-sectional descriptive study conducted at Shaikh Zayed Hospital, Lahore, from 1st January 2006 to 30[th] June 2007. The study included 44 adult patients of both genders diagnosed as having ITP according to WHO guidelines. Bone marrow biopsy was carried out in all patients and other causes of thrombocytopaenia were carefully excluded. Antinuclear antibodies, rheumatoid factor, HBs Ag, anti HCV, HIV were also done. The data was analysed by SPSS version 10. Results showed peak incidence in third decade with female to male ratio of 3.1:. Bleeding and bruising were common symptoms of ITP. Seven [15.9%] of 44 patients had serological evidence of systemic autoimmune disorders, i.e., SLE or RA. Platelet count was significantly lower in SLE patients than in entire cohort. It was concluded that adult ITP is predominantly seen in young females, presents with bleeding from more than 2 sites and may be associated with autoimmune disorders at the time of diagnosis